Bendib K, Poirier C, Croisille P, Roux J P, Revel D, Amiel M
CREATIS-UMR CNRS 5515, Département d'Imagerie Diagnostique et Thérapeutique, Hôpital L Pradel, Lyon.
J Radiol. 1999 Nov;80(11):1561-7.
Accurate assessment of arterial stenosis is a major public health issue for the diagnosis and treatment of cardiovascular diseases. The number of imaging techniques and types of software for display of imaging data is increasing. Few studies that compare these different techniques are available in the literature.
Using phantoms to reproduce the main types of arterial stenosis, the authors compared three 3D acquisition techniques (MRA, CTA, and 3D DSA) and four types of display methods (MIP, SR, MPVR, and VA). The degree, the shape, and the location of different types of stenoses were analyzed by three experienced observers during two successive readings. Intra- and inter-observer reproducibility were assessed. The results of the various acquisition techniques and display methods also were compared to the digital reference data (CFAO) of the physical phantoms.
The degree of intra- and inter-observer reproducibility for the assessment of shape and location of the stenoses was good. Visual assessment of the degree of stenosis showed significant differences between two observers as well as in two readings by one observer. The 3D DSA was the most accurate technique for assessing the degree of stenosis. CTA provided better results than MRA. MPVR provided an accurate assessment of the degree of the stenosis. 3D DSA and CTA assessed stenosis form and localization adequately, with no significant difference; both methods appeared to be more accurate than MRA. SR provided the best information on the eccentric nature of the stenosis. The shape was very well assessed by VA and MPVR.
Even though 3D DSA is the most accurate acquisition technique for visualization, the combined use of SR and MPVR appears to be the best compromise to describe the morphology and degree of stenosis. Further improvements in automatic 3D image processing could offer a better understanding and increased possibilities for assessing arterial stenosis.
准确评估动脉狭窄是心血管疾病诊断和治疗中的一个重大公共卫生问题。用于显示成像数据的成像技术和软件类型不断增加。文献中很少有比较这些不同技术的研究。
作者使用模型再现动脉狭窄的主要类型，比较了三种三维采集技术（磁共振血管造影、计算机断层血管造影和三维数字减影血管造影）和四种显示方法（最大密度投影、表面重建、多平面容积再现和容积分析）。由三位经验丰富的观察者在连续两次读数过程中分析不同类型狭窄的程度、形状和位置。评估观察者内和观察者间的可重复性。还将各种采集技术和显示方法的结果与物理模型的数字参考数据（CFAO）进行比较。
观察者内和观察者间对狭窄形状和位置评估的可重复性良好。对狭窄程度的视觉评估显示，两位观察者之间以及一位观察者的两次读数之间存在显著差异。三维数字减影血管造影是评估狭窄程度最准确的技术。计算机断层血管造影的结果优于磁共振血管造影。多平面容积再现对狭窄程度提供了准确的评估。三维数字减影血管造影和计算机断层血管造影对狭窄形态和定位的评估充分，无显著差异；这两种方法似乎比磁共振血管造影更准确。表面重建提供了关于狭窄偏心性质的最佳信息。容积分析和多平面容积再现对形状的评估非常好。
尽管三维数字减影血管造影是可视化最准确的采集技术，但表面重建和多平面容积再现的联合使用似乎是描述狭窄形态和程度的最佳折衷方案。自动三维图像处理的进一步改进可能会为评估动脉狭窄提供更好的理解和更多可能性。
